Hindawi Publishing Corporation Infectious Diseases in Obstetrics and Gynecology Volume 2015, Article ID 508482, 5 pages http://dx.doi.org/10.1155/2015/508482
Research Article Perinatal Outcomes in HIV Positive Pregnant Women with Concomitant Sexually Transmitted Infections Erin Burnett, Tammy L. Loucks, and Michael Lindsay Department of Gynecology and Obstetrics, Emory University School of Medicine, 69 Jesse Hill Jr. Drive SE, Glenn Building, 4th Floor, Atlanta, GA 30303, USA Correspondence should be addressed to Erin Burnett; [email protected] Received 8 December 2014; Accepted 22 March 2015 Academic Editor: Per Anders Mardh Copyright © 2015 Erin Burnett et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Objective. To evaluate whether HIV infected pregnant women with concomitant sexually transmitted infection (STIs) are at increased risk of adverse perinatal and neonatal outcomes. Methods. We conducted a cohort study of HIV positive women who delivered at an inner-city hospital in Atlanta, Georgia, from 2003 to 2013. Demographics, presence of concomitant STIs, prenatal care information, and maternal and neonatal outcomes were collected. The outcomes examined were the association of the presence of concomitant STIs on the risk of preterm birth (PTB), postpartum hemorrhage, chorioamnionitis, preeclampsia, intrauterine growth restriction, small for gestational age, low Apgar scores, and neonatal intensive care admission. Multiple logistic regression was performed to adjust for potential confounders. Results. HIV positive pregnant women with concomitant STIs had an increased risk of spontaneous PTB (odds ratio (OR) 2.11, 95% confidence interval [CI] 1.12–3.97). After adjusting for a history of preterm birth, maternal age, and low CD4+ count at prenatal care entry the association between concomitant STIs and spontaneous PTB persisted (adjusted OR 1.96, 95% CI 1.01–3.78). Conclusions. HIV infected pregnant women with concomitant STIs relative to HIV positive pregnant women without a concomitant STI are at increased risk of spontaneous PTB.
1. Introduction Human immunodeficiency virus (HIV) infections continue to increase in the United States. As of 2012 an estimated 1.3 million people living in the United States are HIV positive (0.6% of USA population) [1]. According to data from the US Global Health policy released in December 2012, there are 50,000 new HIV infections yearly in the United States. HIV infections among women, especially those of reproductive age, have also dramatically increased in the past 2 decades [1]. Further, observational studies conducted in the United States have documented a link between HIV infection and adverse pregnancy outcomes including low birth weight (LBW), preterm birth (PTB), and small for gestational age (SGA) infants [2–6]. The prevalence of sexually transmitted infections (STIs) in the United States is increasing and the majority of these infections occur in women of reproductive age. A 2007 study estimated that 15 million new STIs occur annually and that 13.3% of these, about 2 million, occur in pregnant women [7].
In 2011 the Centers for Disease Control and Prevention (CDC) reported that the overwhelming majority of all infections in females occurred in women of reproductive age [8]. Multiple observational studies performed in the United States have linked selected STIs, including gonorrhea, chlamydia, trichomoniasis, human papillomavirus (HPV), syphilis, and herpes simplex virus, to poor perinatal and neonatal outcomes including, intrauterine growth restrictions (IUGR), preterm labor (PTL), preterm birth (PTB), premature rupture of membranes (PROM), chorioamnionitis, LBW, and postpartum endometritis [9–13]. Current evidence supports a link between HIV infection and adverse perinatal outcomes as well as a link between STIs and adverse perinatal outcomes. However, there is a paucity of data on perinatal outcomes in HIV positive women with concomitant STIs. To address this knowledge gap we identified a cohort of HIV infected pregnant women who received prenatal care and delivered at an inner-city hospital. We examined the hypothesis that concomitant STIs would be associated with
2 an increased risk for adverse perinatal and neonatal outcomes in this HIV positive cohort.
2. Methods A cohort of all HIV infected women who delivered at Grady Memorial Hospital (GMH) over a span of 10.5 years was identified. GMH is an inner city hospital which provides care for indigent patients throughout the metropolitan Atlanta area, the majority of which are minorities. HIV infected women were followed during pregnancy in a HIV specific obstetrical clinic run by the maternal fetal medicine fellows under the direction of the same fellowship director during the entire study period. Treatment protocol for HIV was in accordance with the most up to date National Institute of Health (NIH) recommendations at the time. Every effort is made for STIs treatment immediately upon diagnosis. This study received approval from the Institutional Review Board, at Emory University and the Grady Memorial Hospital Research Oversight Committee (IRB study # 00064558). The medical and delivery records of all HIV positive women with singleton pregnancies delivered at GMH from January 1, 2003, through May 31, 2013, were reviewed. Pregnancies ending in a spontaneous or therapeutic abortion at
Research Article Perinatal Outcomes in HIV Positive Pregnant Women with Concomitant Sexually Transmitted Infections Erin Burnett, Tammy L. Loucks, and Michael Lindsay Department of Gynecology and Obstetrics, Emory University School of Medicine, 69 Jesse Hill Jr. Drive SE, Glenn Building, 4th Floor, Atlanta, GA 30303, USA Correspondence should be addressed to Erin Burnett; [email protected] Received 8 December 2014; Accepted 22 March 2015 Academic Editor: Per Anders Mardh Copyright © 2015 Erin Burnett et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Objective. To evaluate whether HIV infected pregnant women with concomitant sexually transmitted infection (STIs) are at increased risk of adverse perinatal and neonatal outcomes. Methods. We conducted a cohort study of HIV positive women who delivered at an inner-city hospital in Atlanta, Georgia, from 2003 to 2013. Demographics, presence of concomitant STIs, prenatal care information, and maternal and neonatal outcomes were collected. The outcomes examined were the association of the presence of concomitant STIs on the risk of preterm birth (PTB), postpartum hemorrhage, chorioamnionitis, preeclampsia, intrauterine growth restriction, small for gestational age, low Apgar scores, and neonatal intensive care admission. Multiple logistic regression was performed to adjust for potential confounders. Results. HIV positive pregnant women with concomitant STIs had an increased risk of spontaneous PTB (odds ratio (OR) 2.11, 95% confidence interval [CI] 1.12–3.97). After adjusting for a history of preterm birth, maternal age, and low CD4+ count at prenatal care entry the association between concomitant STIs and spontaneous PTB persisted (adjusted OR 1.96, 95% CI 1.01–3.78). Conclusions. HIV infected pregnant women with concomitant STIs relative to HIV positive pregnant women without a concomitant STI are at increased risk of spontaneous PTB.
1. Introduction Human immunodeficiency virus (HIV) infections continue to increase in the United States. As of 2012 an estimated 1.3 million people living in the United States are HIV positive (0.6% of USA population) [1]. According to data from the US Global Health policy released in December 2012, there are 50,000 new HIV infections yearly in the United States. HIV infections among women, especially those of reproductive age, have also dramatically increased in the past 2 decades [1]. Further, observational studies conducted in the United States have documented a link between HIV infection and adverse pregnancy outcomes including low birth weight (LBW), preterm birth (PTB), and small for gestational age (SGA) infants [2–6]. The prevalence of sexually transmitted infections (STIs) in the United States is increasing and the majority of these infections occur in women of reproductive age. A 2007 study estimated that 15 million new STIs occur annually and that 13.3% of these, about 2 million, occur in pregnant women [7].
In 2011 the Centers for Disease Control and Prevention (CDC) reported that the overwhelming majority of all infections in females occurred in women of reproductive age [8]. Multiple observational studies performed in the United States have linked selected STIs, including gonorrhea, chlamydia, trichomoniasis, human papillomavirus (HPV), syphilis, and herpes simplex virus, to poor perinatal and neonatal outcomes including, intrauterine growth restrictions (IUGR), preterm labor (PTL), preterm birth (PTB), premature rupture of membranes (PROM), chorioamnionitis, LBW, and postpartum endometritis [9–13]. Current evidence supports a link between HIV infection and adverse perinatal outcomes as well as a link between STIs and adverse perinatal outcomes. However, there is a paucity of data on perinatal outcomes in HIV positive women with concomitant STIs. To address this knowledge gap we identified a cohort of HIV infected pregnant women who received prenatal care and delivered at an inner-city hospital. We examined the hypothesis that concomitant STIs would be associated with
2 an increased risk for adverse perinatal and neonatal outcomes in this HIV positive cohort.
2. Methods A cohort of all HIV infected women who delivered at Grady Memorial Hospital (GMH) over a span of 10.5 years was identified. GMH is an inner city hospital which provides care for indigent patients throughout the metropolitan Atlanta area, the majority of which are minorities. HIV infected women were followed during pregnancy in a HIV specific obstetrical clinic run by the maternal fetal medicine fellows under the direction of the same fellowship director during the entire study period. Treatment protocol for HIV was in accordance with the most up to date National Institute of Health (NIH) recommendations at the time. Every effort is made for STIs treatment immediately upon diagnosis. This study received approval from the Institutional Review Board, at Emory University and the Grady Memorial Hospital Research Oversight Committee (IRB study # 00064558). The medical and delivery records of all HIV positive women with singleton pregnancies delivered at GMH from January 1, 2003, through May 31, 2013, were reviewed. Pregnancies ending in a spontaneous or therapeutic abortion at
